Housing, care and welfare for the elderly

The Court of Audit makes the following recommendations concerning the direction of the policy on housing, care and social welfare services for the elderly:

• The ministers must devise a guiding framework which sets out conditions within which local policy implementation should take place. Those implementing the policy at local level must be kept fully informed of central government's intentions.

• The ministers must be clear as to who should take the lead in coordination at local level. At the moment, this role is split between the local authorities and the health care administration offices. The main concern is not powers, but the legitimacy of the role, to ensure that all relevant actors play a constructive part in consultations, under the leadership of the party responsible for directing policy implementation.

The Court of Audit makes the Minister of Health, Welfare and Sport the following recommendations concerning the social welfare function and the position of vulnerable elderly people:

• The Minister must make it clear to the local authorities in the short term what resources are available to finance their social welfare activities, which are growing as a result of the assisted living policy and demographic ageing.

• The Minister must consider how acceptable it is that there are no national standards concerning the minimum level of assistance available to vulnerable elderly people (such as those suffering from dementia and elderly psychiatric patients) who live independently.

4. Official response

The Court of Audit received responses to this investigation from the Minister of Housing, Spatial Planning and the Environment, the State Secretary for Health, Welfare and Sport, the Association of Provincial Authorities (IPO) and the Association of Netherlands Municipalities (VNG).

5. Response of the Minister of Housing, Spatial Planning and the Environment and the State Secretary for Health, Welfare and Sport

The Minister and State Secretary submitted a joint response on 29 April 2003. They both regard this as a very important area of policy. They therefore welcomed the Court of Audit's investigation. They agree with the Court that objectives and performance must be set out as specifically as possible according to the VBTB system. This matter will continue to receive their attention.

The Minister and State Secretary believe that sufficient policy information is available. A guiding framework is not felt to be appropriate, because central government must avoid hampering the local parties with excessively stringent conditions or constant reference to targets. They are not keen to designate a single party to direct matters in this policy area. Thorough arrangements have been made concerning each party's responsibilities. They must actively set about meeting their responsibilities and show a willingness to work together. The Minister and State Secretary acknowledge that local authorities may face problems financing social welfare services for elderly people living independently, whose numbers are growing all the time. Measures to deal with this problem are being considered (new services system). Finally, the Minister and State Secretary state that there is no need to take a position on national standards for a minimum level of assistance for vulnerable elderly people living independently, as the Court recommends, as standards for all health insurance policy holders, including vulnerable groups, already exist.

6. IPO response

The Association of Provincial Authorities (IPO) supports the idea that the implementation of policy at local level needs to be cast in more concrete form. It believes that the Court of Audit failed to focus enough attention on the regional level. The IPO calls for government policy to be made more effective by bringing in the intermediate level - the provincial authorities. All provinces are actively concerned with housing, care and social welfare services for the elderly, and make major investments in this area.

7. VNG response

The Association of Netherlands Municipalities (VNG) agrees with the Court of Audit's analysis of the policy issues in the field of housing, care and social welfare services for the elderly. However, it feels that the conclusions and recommendations could have been worded more strongly. The VNG believes that local authorities should take the lead in coordinating policy implementation at local level. It also calls for two amendments to the Municipalities (Preferential Rights) Act that would expand its scope to all local authorities and simplify the procedure for establishing a preferential right. The temporary Assisted Living Incentive Scheme should be made permanent. The VNG believes local authorities have an important role to play in improving the policy information available to central government. However, it would need financial resources from central government in order to fulfil this potential.

8. Court of Audit afterword

In its afterword the Court of Audit examines the responses of the Minister, State Secretary, IPO and VNG. It observes that work is underway on a policy information system which will allow policy effects to be assessed in the future. It regrets the fact that the Minister and State Secretary are reluctant to set a guiding framework, as it could have given a clear indication of the point when residential care becomes a must and of how the sixth 'performance field' in the Subsidised Rented Sector (Management) Decree is to be elaborated. The Court of Audit finds it regrettable that the Ministry and State Secretary fail to get to grips with the problem of both local authorities and health care administration offices taking a lead role in the local implementation of policy on housing, care and social welfare services for the elderly. It would also point out that it called for a position on specific standards for vulnerable groups, not for general standards.

The Minister of Housing, Spatial Planning and the Environment and the State Secretary for Health, Welfare and Sport say that they regard housing, care and social welfare services for the elderly as an important policy area. The Court of Audit believes they have shown a great deal of reluctance to take up its recommendations. Because of the ageing population, those who implement the policy locally face a difficult task. Without adequate guidance, the policy will become too removed from its implementation. The Court of Audit would call for renewed attention to be given to this issue, as a matter of urgency.